Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study

Background Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.

背景暴露和预防反应是一种认知行为疗法，是一种有效的强迫症（OCD）的一线治疗方法。尽管广泛的证据表明临床研究和现实样本中暴露和预防反应预防（ERP）的功效，但它仍然没有用作治疗方法。这很可能是由于获得护理的限制，其中包括训练有素的治疗师的可用性以及地理位置，时间和成本障碍。为了解决这些问题，NOCD使用通过视频远程疗法提供的ERP以及技术辅助元素（包括基于应用程序的治疗工具和会议间的治疗师消息传递）创建了OCD的数字行为健康治疗。目的，我们检查了3552名接受NOCD治疗的主要强迫症诊断的大量自然主义样本中的治疗结果。方法该治疗模型由每周两次，现场直播，面对面的视频远程疗法ERP组成3周，然后进行6周的每周一次简短的视频远程疗法检查30分钟。评估是在基线，在每周两次的3周完成后以及6周结束时（端点）的6周结束时进行评估。在终点后的3、6、9和12个月，还获得了纵向评估。结果治疗导致临床和统计学上的显着改善，强迫症症状的平均降低为43.4％（G = 1.0; 95％CI 0.93至1.03），反应率为62.9％。治疗还导致抑郁症的平均减少，47.8％的焦虑平均降低以及压力症状的平均减少37.3％。生活质量平均提高了22.7％。轻度，中度或严重症状的人的强迫症症状降低和反应率相似。平均治疗持续时间为11.5（SD 4.0）周，平均总治疗师时间为10.6（SD 1.1）小时。在3、6、9和12个月维持改进。在该样本中得出的结论是迄今为止报告的最大的OCD患者的研究，视频远程疗法治疗表明在减少强迫症和合并症症状以及改善生活质量方面有效。此外，与每周一次的门诊治疗相比，它的总治疗师时间不到一半的总治疗师时间，这一效率代表了可观的货币和时间节省。效果大小很大，与面对面ERP的研究相似。这种由技术辅助的远程治疗很容易为患者使用，在传播有效的OCD基于循证的护理方面提供了该领域的进步。